Two-Dimensional Radiological Analysis of Tibial Malalignment After Intramedullary Nailing: Prevalence, Associated Factors, and Outcomes

Abstract

INTRODUCTION: Tibial fractures are common long-bone fractures treated by orthopaedic surgeons. Intramedullary nailing (IMN) is the preferred standard treatment for tibial diaphysis fractures. This study aimed to evaluate the prevalence of tibial malalignment, its associated factors, and the outcomes following IMN. MATERIALS AND METHODS: A retrospective cross-sectional study was conducted on skeletally mature patients aged over 18 years who underwent IMN for tibial diaphysis fractures at a single academic trauma centre from January 2015 to December 2023. Data were extracted from the hospital database, including plain radiographs, medical records, and intraoperative notes. The Pearson chi-square test was used to examine the outcomes of malalignment, followed by logistic regression analyses to identify factors associated with tibial malalignment. RESULTS: A total of 163 patients were analysed. The prevalence of tibial malalignment following IMN was 66.0% in the proximal third, 58.8% in the distal third, and 25.0% in the middle third. The degree of comminution, specifically in Type 42C fractures, and lateral nail entry point were significantly associated with malalignment (p=0.02 and 0.011, respectively). However, no significant correlation was found between malalignment and bone union. CONCLUSION: Tibial malalignment is most common in the proximal third following IMN, with the degree of comminution being a significant factor. Despite the high prevalence of malalignment, it did not adversely affect bone union. These insights can guide preoperative planning and intraoperative techniques to optimize patient outcomes in tibial diaphysis fractures.